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PAGE OF Form DWMRC05 01/16 CUMULATIVE OCCUPATIONAL EXPOSURE HISTORY 1. NAME (LAST, FIRST, MIDDLE INITIAL) 2. IDENTIFICATION NUMBER 3. ID TYPE 5. DATE OF BIRTH MALE 4. SEX FEMALE 6. MONITORING PERIOD

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How to fill out occupational exposure history

01

Step 1: Gather all necessary information about your occupational exposure history, such as job title, company name, and work duration.

02

Step 2: Start with your earliest job and work your way chronologically through each occupational position you held.

03

Step 3: For each job, detail the potential hazards or substances you were exposed to, such as chemicals, fumes, dust, or radiation.

04

Step 4: Record the level or intensity of exposure for each hazard, if known.

05

Step 5: Include any personal protective equipment (PPE) used during each job, if applicable.

06

Step 6: Add any measures or precautions taken to minimize exposure to hazards.

07

Step 7: Review and double-check all the information you have provided for accuracy and completeness.

08

Step 8: Submit the completed occupational exposure history form to the relevant authority or employer, as required.

Who needs occupational exposure history?

01

Occupational exposure history is needed by professionals in occupational health and safety, including doctors, nurses, and industrial hygienists.

02

Employers may also require occupational exposure history from employees as part of health surveillance or risk assessment procedures.

03

Workers who have been exposed to occupational hazards or substances themselves may need to provide this history for medical or legal reasons.

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What is occupational exposure history?

Occupational exposure history is a record of an individual's exposure to harmful substances or conditions in the workplace.

Who is required to file occupational exposure history?

Employees who are exposed to hazardous materials or conditions in the workplace are required to file occupational exposure history.

How to fill out occupational exposure history?

Occupational exposure history can be filled out by documenting the dates, types of exposure, protective measures taken, and any resulting health effects.

What is the purpose of occupational exposure history?

The purpose of occupational exposure history is to track and monitor an individual's exposure to hazardous substances or conditions in the workplace in order to prevent health problems.

What information must be reported on occupational exposure history?

Information such as the type of hazardous substances, dates of exposure, protective measures taken, and any health effects must be reported on occupational exposure history.

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